How Texas is sparking mental health innovation

As noted recently by The Wall Street Journal, “governors and lawmakers in a number of states are pushing for billions of dollars in funding increases for mental health this year, as Republicans and Democrats alike say that a shortage of available services has reached crisis levels.” As states such as California, South Carolina, New York, Wisconsin, Ohio, and Georgia forge ahead with new funding aimed at improving lives, the Lone Star state offers a roadmap for success.

With the formation of the Texas Child Mental Health Care Consortium (TCMHCC) in 2019, the Texas legislature took a bold step forward in creating a multi-pronged approach to mental health care delivery in the state. Comprising the 13 state-funded health related institutions of higher learning in Texas alongside non-profits and other government or administrative ancillaries, the Consortium has major initiatives spanning the mental health education of primary care providers, access to mental health services in schools, increasing psychiatry residencies and fellowships, and more. Key programs include:

  • The Texas Child Health Access Through Telemedicine (TCHATT) program, which provides in-school behavioral telehealth care to at-risk children and adolescents.
  • The Child Psychiatry Access Network (CPAN), which provides telehealth-based consultation and behavioral health training to primary care providers.
  • The Perinatal Psychiatry Access Network (PeriPAN), a new pilot hotline for clinician-to-clinician consultation for OB/GYN and other providers serving pregnant women and new mothers experiencing mental health distress.

The programs fit with a trend nationally: the Health Resources & Services Administration (HRSA) has funded programs in 40 states so far to provide consultations and resources to pediatric primary care providers or OB/GYNs. However, while pediatric and maternal mental health care access programs are fairly well-established across the nation, the Consortium itself is fairly unique and the TCHATT program represents a best-in-class approach to meeting kids where they are: at school. Statistics show that just over half of public schools nationally are providing diagnostic mental health assessments and only 42% are providing treatment (with that treatment varying widely in terms of scope and efficacy). TCHATT goes a step beyond to provide telemedicine consults, referrals to mental health specialists, and coordinated follow-through and care coordination throughout the student’s participation in the program, typically spanning five consultations as well as interaction with the family.

Connecting access to outcomes

As the saying goes, “you can’t manage what you can’t measure.” This adage rings especially true for mental health, where care can be subjective. Yet, subjectivity doesn’t lend itself to increased funding. Funders – including legislators and federal agencies – typically want to see the real-world impact and improved patient health outcomes for the money they spent. Here again, Texas has bucked the norm. As the technology partner for TCMHCC across the TCHATT, PeriPAN, and CPAN programs, over 7,000 school counselors in Texas and 1,000 behavioral health specialists are using Trayt’s applications and have served over 43,000 students across the state. Based on participant data collected by Trayt and presented to the TCMHCC Executive Committee in February 2023, Trayt helped deploy and assess interventions that have resulted in clinically significant improvements in depression for TCHATT patients evaluated by the PHQ-9A (a diagnostic tool for mental health disorders for use in screening adolescents). These impacts were consistent across demographic, gender, and geographic lines, building a strong case for the health equity impacts of the Consortium.

It’s no surprise then that, as reported by Houston Public Media, the Texas legislature wants to double its investment in student mental health resources with first drafts of the appropriations bills showing the Texas House and Senate allocating $280 million over the next two fiscal years.

As funding swells across the nation as well, other states would do well to look at what’s happening in Texas. By intentionally and thoughtfully focusing on programs that enable care delivery and establish streamlined systems, other states can clearly and concisely measure program quality and patient health outcomes for those they serve.